Cardiovascular risk and blood pressure control in a Spanish hypertensive population attended in a Primary Care setting. Data from the PRESCAP 2006 study.

AIMS: To analyse the cardiovascular risk of a broad sample of hypertensive patients and to examine whether there are differences in blood pressure control and associated factors according to the different cardiovascular risk categories. MAJOR FINDINGS: A total of 10,520 patients > or = 18 years old were included (mean age 64.6+/-11.3 years; 53.7% women). In this cohort, 3.3% were average risk, 22.6% low added risk, 22.2% moderate added risk, 33.5% high added risk and 18.4% very high added risk. Blood pressure was controlled in 41.4% (95% CI 40.5-42.4) of the total population, in 91.7% of patients with low added risk, in 19.4% with moderate added risk, in 27.4% with high added risk and in 6.8% with very high added risk. Diabetes was the factor most strongly associated with poor blood pressure control in patients with high to very high added risk (OR=7.2; p<0.0001). PRINCIPAL CONCLUSION: More than half of the hypertensive patients treated in primary health care have a high or very high added cardiovascular risk. In these patients, blood pressure control is inadequate and diabetes is associated with a sevenfold increase in the likelihood of poor blood pressure control.

[Control of blood pressure in Spanish hypertensive population attended in primary health-care. PRESCAP 2006 Study]. / Control de la presión arterial en la población hipertensa española atendida en atención primaria. Estudio PRESCAP 2006.

BACKGROUND AND OBJECTIVES: More information is needed on hypertension control and its evolution in clinical practice. This study aimed to determine the degree of blood pressure (BP) control in Spanish hypertensive patients attended in primary care (PC) and to determine the factors associated with poor BP control. PATIENTS AND METHOD: Cross-sectional, multicenter study, carried out in PC settings throughout Spain. Hypertensive patients >or= 18 years, with antihypertensive treatment (>or= 3 months) were consecutively recruited. BP measurement was performed in surgery hours (morning and evening) following standardized methods and averaging 2 consecutive readings. BP control was regarded as optimum when BP values were < 140/90 mmHg in general population and <130/80 mmHg in patients with diabetes, chronic renal disease or cardiovascular disease. RESULTS: 10,520 hypertensive patients were included (53.7% women), mean age (SD) 64.6 (11.3) years. 41.4% (95% confidence interval [CI], 40.5-42.4) presented good systolic BP (SBP) and diastolic BP (DBP) control, 46.5% (95% CI, 45.5-47.4) only SBP control and 67.1% (95% CI, 66.2-68.0) only DBP control. 55.6% of patients were treated with combination therapy (41.2% 2 drugs, 11.7% 3 and 2.8% more than 3). BP control was significantly (p<0.001) higher in the evening measurement (48.9%) than in the morning measurement (40.5%), and if patients had taken the treatment before measurement (42.0%) compared with those who had not taken it (38.8%). Factors such as diabetes, cardiovascular disease, sedentary lifestyle, alcohol consumption and surgery hour were associated with poor BP control (p<0.001). CONCLUSIONS: The results of the PRESCAP 2006 study indicate that 4 out of 10 hypertensive patients treated in PC in Spain have an optimal BP control. The degree of control of arterial hypertension has improved remarkably with respect to the PRESCAP 2002 study.

Control de la presión arterial en la población hipertensa española atendida en atención primaria. Estudio PRESCAP 2006 / Control of blood pressure in Spanish hypertensive population attended in primary health-care. PRESCAP 2006 Study

Fundamento y objetivos: Es necesario tener mayor información sobre el grado de control de la hipertensión arterial (HTA) en condiciones reales de la práctica clínica. Los objetivos de este estudio fueron conocer el grado de control de presión arterial (PA) en pacientes hipertensos en atención primaria (AP) y determinar los factores asociados al mal control. Pacientes y método: Estudio transversal y multicéntrico que incluyó a individuos hipertensos de 18 o más años, que seguían tratamiento farmacológico antihipertensivo desde hacía al menos 3 meses, y que fueron seleccionados consecutivamente en consultas de AP de España. La medida de PA se realizó siguiendo normas estandarizadas según el horario de consulta (matutina o vespertina) y se calculó la media aritmética de 2 tomas sucesivas. Se consideró que había buen control cuando el promedio era inferior a 140/90 mmHg en general, y menor de 130/80 mmHg en pacientes con diabetes, insuficiencia renal o enfermedad cardiovascular. Resultados: Se incluyó a 10.520 hipertensos (53,7% mujeres), con edad media (desviación estándar) de 64,6 (11,3) años. El 41,4% (intervalo de confianza [IC] del 95%, 40,5-42,4) presentó un buen control de PA sistólica (PAS) y PA diastólica (PAD), el 46,5% (IC del 95%, 45,5-47,4) sólo de PAS y el 67,1% (IC del 95%, 66,2-68,0) sólo de PAD. El 55,6% recibía tratamiento combinado (41,2% 2 fármacos, 11,7% 3 fármacos, y 2,8% más de 3). El porcentaje de pacientes controlados fue significativamente mayor (p < 0,001) por las tardes (48,9%) que por las mañanas (40,5%), y en pacientes que habían tomado tratamiento antihipertensivo el día de la visita (42,0%) frente a los que no lo habían tomado (38,8%). La diabetes, la enfermedad cardiovascular, el sedentarismo, el consumo elevado de alcohol y el horario de consulta fueron los factores más asociados al mal control de la HTA (p < 0,001). Conclusiones: Los resultados del estudio PRESCAP 2006 indican que 4 de cada 10 pacientes hipertensos tratados y atendidos en AP en España tienen controlada óptimamente su HTA. Hay diferencias importantes en el grado de control según el horario de consulta y la toma previa de antihipertensivos. El control de la HTA ha mejorado apreciablemente respecto al PRESCAP 2002

Background and objectives: More information is needed on hypertension control and its evolution in clinical practice. This study aimed to determine the degree of blood pressure (BP) control in Spanish hypertensive patients attended in primary care (PC) and to determine the factors associated with poor BP control. Patients and method: Cross-sectional, multicenter study, carried out in PC settings throughout Spain. Hypertensive patients $ 18 years, with antihypertensive treatment ($ 3 months) were consecutively recruited. BP measurement was performed in surgery hours (morning and evening) following standardized methods and averaging 2 consecutive readings. BP control was regarded as optimum when BP values were < 140/90 mmHg in general population and < 130/80 mmHg in patients with diabetes, chronic renal disease or cardiovascular disease. Results: 10,520 hypertensive patients were included (53.7% women), mean age (SD) 64.6 (11.3) years. 41.4% (95% confidence interval [CI], 40.5-42.4) presented good systolic BP (SBP) and diastolic BP (DBP) control, 46.5% (95% CI, 45.5-47.4) only SBP control and 67.1% (95% CI, 66.2-68.0) only DBP control. 55.6% of patients were treated with combination therapy (41.2% 2 drugs, 11.7% 3 and 2.8% more than 3). BP control was significantly (p < 0,001) higher in the evening measurement (48.9%) than in the morning measurement (40.5%), and if patients had taken the treatment before measurement (42.0%) compared with those who had not taken it (38.8%). Factors such as diabetes, cardiovascular disease, sedentary lifestyle, alcohol consumption and surgery hour were associated with poor BP control (p < 0,001). Conclusions: The results of the PRESCAP 2006 study indicate that 4 out of 10 hypertensive patients treated in PC in Spain have an optimal BP control. The degree of control of arterial hypertension has improved remarkably with respect to the PRESCAP 2002 study